drug medi-cal organized delivery system medication ......treatment program (ntp) services in...
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Drug Medi-Cal Organized Delivery System: Medication Assisted
Treatment Frequently Asked Questions
Technical Assistance Webinar for CountiesAugust 2, 2018
Overview of Presentation
• State Updates• Medication Assisted Treatment (MAT)
Frequently Asked Questions (FAQ)• Questions and Discussion• Adjourn
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State Updates
Drug Medi-Cal Organized Delivery System (DMC-ODS)MAT FAQs
Michele WongDepartment of Health Care Services (DHCS)Substance Use Disorder Compliance Division
August 2, 2018
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Required MAT in DMC-ODS
Medication Assisted Treatment
What is MAT?• MAT is the use of prescription medications, in
combination with counseling and behavioral therapies, to provide a whole-person approach to the treatment of substance use disorders (SUDs).
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Can residential or outpatient providers refuse to treat a beneficiary who is utilizing MAT? • No. Residential and outpatient facilities cannot deny
a patient utilizing or needing MAT from program participation.
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Beneficiary Rights
What are provider requirements under the DMC-ODS related to MAT?Counties must require:• That providers have procedures and protocols in
place to assure care coordination and linkage to other services and supports for beneficiaries receiving MAT.
• Regular communication with the physicians of the beneficiaries who are prescribed these medications, unless the beneficiary chooses not to consent to signing a 42 CFR Part 2-compliant release of information for this purpose.
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DMC-ODS Requirements
What MAT services must be made available under the DMC-ODS (a.k.a. “required” MAT)?• Counties contracting to participate in DMC-ODS are
required to cover and ensure access to Narcotic Treatment Program (NTP) services in NTP-licensed settings.
• Services are provided in accordance with an individualized treatment plan determined by a licensed physician or licensed prescriber and approved and authorized according to the State of California requirements.
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Required MAT under the DMC-ODS
Narcotic Treatment Programs
What medications are required to be available through NTPs under DMC-ODS?• Medications required to be available through NTPs
under DMC-ODS include: Methadone Buprenorphine Naloxone Disulfiram
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What are the components of NTP services?• NTP service components include: Intake Individual and Group Counseling Patient Education Medication Services Collateral Services Crisis Intervention Services Treatment Planning Medical Psychotherapy Discharge Services
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Narcotic Treatment Programs
Are there counseling requirements for NTP services?• Yes. A patient must receive at minimum 50 minutes
of counseling sessions with a therapist or counselor for up to 200 minutes per calendar month.
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Narcotic Treatment Programs
Where can NTP services be provided?• NTP services may only be provided in NTP-licensed
settings.
Can counties require prior authorization for NTP services?• No. NTP services under DMC-ODS shall not require
prior authorization.
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Narcotic Treatment Programs
What are the reimbursement rates for NTP?• The statewide rates are published annually by DHCS
via Information Notices (INs). • The Fiscal Year 17-18 reimbursement rates for
methadone are reported in MHSUDS IN 17-018. • The rates for buprenorphine, disulfiram, and
naloxone are reported in MHSUDS IN 17-029.• For updates, check:
http://www.dhcs.ca.gov/formsandpubs/Pages/MHSUDS-Information-Notices.aspx
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Narcotic Treatment Programs
Is the National Drug Code (NDC) required for claiming medications at an NTP?• Claims for medications other than methadone must
include the NDC. This applies to NTP and non-NTP settings.
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Narcotic Treatment Programs
What is naloxone? • Naloxone is a life-saving medication that works to
reverse an opioid overdose while having little to no effects on an individual if opioids are not present in their system.
• The medication can be given by intranasal spray, intramuscular (into the muscle), subcutaneous (under the skin), or intravenous injection.
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Naloxone
Where is naloxone allowed?• Licensed residential treatment programs and
certified outpatient DMC treatment programs are permitted to utilize naloxone at their program site. All forms of naloxone are allowed.
• NTPs are required to offer naloxone under DMC-ODS.
• For complete information about naloxone, IN 17-048: http://www.dhcs.ca.gov/Documents/MHSUDS_Information_Notice_17_048_Naloxone.pdf
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Naloxone
What are the requirements for DMC-ODS sites that provide naloxone?• All forms of the medication shall be recorded, stored,
and destroyed in the same manner as prescription medications.
• Programs must have policies, procedures, and protocols related to how the medication will be stored, any documentation associated with the administration of it, and disposal.
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Naloxone
Can the requirement to offer naloxone at an NTP be met by offering a form of buprenorphine (suboxone) that contains both buprenorphine and naloxone in the formula? • No. While NTPs may offer forms of buprenorphine
that contain naloxone in the formula, this is not a replacement for naloxone.
• Naloxone by itself is used to treat a narcotic overdose in an emergency situation.
• Naloxone as a combo product with buprenorphine is utilized to prevent diversion of the medication.
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Naloxone
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Optional MAT in DMC-ODS
What are the optional MAT services covered under DMC-ODS?• Counties contracting to participate in DMC-ODS may
choose to offer additional MAT beyond the required NTP services. These services shall be described in the county intergovernmental agreement.
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Optional MAT in DMC-ODS
What are the components of optional MAT?The service components include:
• Ordering• Prescribing• Administering• Monitoring
Where can optional MAT services be provided?• Optional MAT services can be provided in a variety
of settings as specified in the county-specific intergovernmental agreement.
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Optional MAT in DMC-ODS
What are the reimbursement rates for optional MAT services covered by individual counties under DMC-ODS?• The rates for optional MAT services (e.g., long-acting
injectable naltrexone) are developed by each county subject to DHCS approval.
Is the NDC required for claiming optional MAT?• Claims for medications other than methadone must
include the NDC. This applies to NTP and non-NTP settings.
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Optional MAT in DMC-ODS
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MAT Outside of DMC-ODS
Are MAT services available outside of DMC-ODS? • Yes. Medi-Cal beneficiaries may access MAT
services outside of DMC-ODS under certain circumstances: Medi-Cal Fee-for-Service (FFS) Medical
Benefit. SUD treatment providers may offer certain MAT services by enrolling physicians as FFS providers and adhering to various registration and other regulatory requirements.
Medi-Cal Pharmacy Benefit. If a FFS physician does not administer the drug and instead writes a prescription for the medication to be dispensed or administered at a pharmacy, the drug cost is covered under the Pharmacy Benefit.
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MAT Services Outside of DMC-ODS
What medications are available outside of DMC-ODS for Medi-Cal beneficiaries? • Medications covered by Medi-Cal that may be
prescribed by an appropriately registered and enrolled FFS physician include: Buprenorphine Injectable Naltrexone Naloxone Disulfiram Acamprosate Other FDA-approved medications for SUD on
Medi-Cal formulary
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MAT Services Outside of DMC-ODS
Is methadone available to Medi-Cal beneficiaries via the FFS Medical or Pharmacy Benefit? • No. Methadone is only available to Medi-Cal
beneficiaries through a certified NTP under the DMC-ODS program (or standard DMC program in non-ODS counties).
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MAT Services Outside of DMC-ODS
What are the requirements for providers that want to order, stock, prescribe, and / or administer buprenorphine via FFS? • Physicians, Nurse Practitioners or Physician
Assistants at SUD facilities who have enrolled as FFS providers also need to obtain a federal DATA 2000 waiver (X number) to prescribe buprenorphine.
• DATA 2000 waivered (X number) Medi-Cal physicians can order, stock, prescribe, and administer covered buprenorphine for treatment of SUDs.
• Medications may be prescribed / dispensed / administered in the office / clinic setting.
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MAT Services Outside of DMC-ODS
Where can I find more information about MAT available through FFS? • The Medi-Cal provider manual is posted online and
contains detailed information about the coverage available under the FFS program.
• The manual is available at: http://files.medi-cal.ca.gov/pubsdoco/Manuals_menu.asp
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MAT Services Outside of DMC-ODS
Questions and Discussion
For optimal sound quality, please ensure that you are dialed-in using your phone and that
you have inputted your audio PIN.
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DMC-ODS Resources
For additional information, please see the DMC-ODS Resources section of the DHCS Website: http://www.dhcs.ca.gov/provgovpart/Pages/DMC_ODS_Resources.aspx
For questions, please contact [email protected]
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Harbage Consulting
Molly Brassil, MSW, Director, Behavioral Health [email protected] Kingdon, PhD, [email protected]
Courtney Kashiwagi, MPH, Program [email protected]
Erynne Jones, MPH, Senior Policy [email protected]
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